Well, someone once said that the clothes maketh the man. Having put on my physician's hat, I found the change in point of view useful so I'm going to continue in that vein for another consultation.
We got you through the door as a straightforward patient suffering from erectile dysfunction (ED). In the light of the question and answer session and your medical history, we gave you the basic physical and, having found nothing to indicate more serious medical conditions, we discussed which of the three medications, Viagra, Cialis and Levitra, would work best for you. We also considered whether you should buy Levitra or any of the other medications online, looking at privacy vs confidence that you would get the medication you paid for.
But this leaves unanswered the question of what other tests might have been applied. We have all this laboratory space and skilled technicians standing by to do a range of tests. So, rather than leaving them standing around unemployed, let's run through a few of their tests.
We'll start with the sex hormones. We can test to see whether there are abnormalities in the levels of testosterone and/or prolactin in the blood. A low level of testosterone can make you less interested in sex and cause an erection problem. Research has shown that men with high blood pressure, diabetes or excessive body weight are twice as likely to have low testosterone levels. The body also produces less testosterone as it ages. This decline usually begins about the age of 40 years and slowly progresses over the next twenty years. It is sometimes referred to as the "male menopause" or "andropause", but the comparison with women is not justified. When women experience their menopause, ovulation ceases and oestrogen production falls rapidly over a relatively period of time.
For the majority of men, the testosterone levels decline naturally over time, but those levels remain within the "normal" range until death, causing no significant problems. In about 20% of men aged sixty and older, the testosterone levels fall below the normal range and produce testosterone deficiency (TD). In addition to growing older, TD can be caused by damage through injury or disease to the hypothalamus or pituitary gland. If the testicles are damaged, this can slow or stop hormone secretion and testosterone production. This latter condition is known as hypogonadism. TD can have a number of different effects:
- a general sense of tiredness and loss of energy;
- a loss of muscle mass and physical strength;
- a loss of libido or impotence;
- a decline in general awareness, memory and thinking processes; or
- anxiety or depression.
But it is important to recognise that other medical conditions such as liver disease, hypothyroidism and depression can cause these symptoms. Similarly, these symptoms may be the side effects of some painkillers, beta blockers and the medications used to treat anxiety and depression. Further, some men who are generally healthy experience one or more of these symptoms because of declining hormones other than testosterone.
For example a high level of prolactin (hyperprolactinemia) can be evidence of an adenoma (a small benign tumor on one of the glands in the brain). These small growths can affect other hormone levels in the body so that libido falls, ED emerges and infertility may result. When this problem occurs in women, a change in the menstrual cycle is a reliable signal of a problem, but many men are not aware of the problem until they have headaches or eye problems caused by the adenoma on the pituitary gland pressing against the optic nerves. So, if ED is reported, testing for prolactin can represent a test to eliminate a less common cause.
Returning to testosterone, there are a number of products on the market as "testosterone therapy". Sales are growing quite strongly. In 2004, pharmacies in the USA supplied 2.4m prescriptions for testosterone, doubling the number filled in 2000. No-one knows whether men or women are buying these medications, nor for what purpose. This is a controversial area because there is no scientific view on whether a slow decline in testosterone levels is an entirely natural effect of growing older or it represents a threat to health that must be treated.
Still wearing my physician's hat, it's time to reach a conclusion or two. There's clinical evidence to show that when younger men suffer any serious reduction in their level of testosterone, low sexual desire, fewer nocturnal erections and low ejaculate volume result. All of these problems are reduced with testosterone therapy. So, I am prepared to offer supplementation alongside Viagra, Cialis or Levitra in this kind of case.
But I prefer not to treat declining levels of testosterone in the average older man. There is no clinical evidence to link the age-dependent decline in testosterone production to any precise sexual symptoms, and when supplementation has been given in clinical trials, it has not produced any relief of sexual problems. Thus, if one of my patients has problems of ED and one of the factors is TD, I will prescribe Viagra, Cialis or Levitra, or recommend where to buy Viagra online as a temporary expedient while exploring other treatment options. But I see no reason to hurry to offer any other form of treatment for the TD unless the testosterone levels have fallen well below the norm for men of that age and body weight.
